Background. In sub-Saharan Africa, intracranial suppurative infections present late and triage—who goes to theatre, who needs monitoring, who can be reassessed—is not formalised. No triage rule specific to these infections has been developed in an African population. Objective. To develop and internally validate an integer triage score using only variables available at presentation, and to define the targets for which prediction fails. Methods. Single-centre cohort, Bouaké Teaching Hospital (2016-2026; 150 admissions, 148 patients). Development endpoint: a composite of in-hospital death, poor functional outcome (Glasgow Outcome Scale ≤ 3) and critical-care use; early surgery was excluded. Twenty-four candidate variables, LASSO selection across ten multiply imputed datasets (60% stability), Firth regression, conversion to integer points, internal validation by 1000 bootstrap resamples of the whole procedure including selection. Pre-specified comparator: continuous Glasgow Coma Scale (DeLong test). Results. The composite occurred in 97 admissions (64.7%). Six variables form the score (0 - 14 points): scalp swelling (4), mass effect (3), impaired consciousness (2), immunosuppression (2), hydrocephalus (2), raised intracranial pressure (1). Optimism-corrected area under the curve 0.788 (0.726 - 0.852); observed risks by band 11.5%, 55.3%, 83.6% and 100%. The score outperformed the Glasgow Coma Scale for the composite (p = 0.002) and for critical-care use (p < 0.001). Pre-specified negative findings: death was not predictable (0.472), and the Glasgow Coma Scale remained superior for functional outcome (p < 0.001). Conclusion. Six items recorded at presentation stratify neurosurgical resource needs. The instrument is not an individual prognosis and requires African multicentre external validation.
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